Your (Gut) Microbiome in Crisis
by Dr. Nancy Rahnama
Director of Health & Nurition
Not too long ago, the digestive system was seen as a pretty simple system. We saw it as one long tube that food passed through, was absorbed, and then excreted. But today, we realize the complexity of the gut and its importance to physical health in general. Many studies over the past twenty years or so have shown clear links between gut health and the immune system, autoimmune diseases, mental health, skin health, endocrine disorders, and even cancer.
If you’ve not yet read the first two installments in this series, I highly recommend you pause here and do so now:
The importance of the gut for overall well-being
The term “gut microbiome” refers to the microorganisms that live in the intestines. Each of us has between 300 and 500 species of bacteria in our digestive tract. Some microorganisms can be harmful to our health, but others are beneficial and necessary.
The problem is, many people’s gut microbiome isn’t balanced, and few people understand what signals and symptoms to look for telling them all is not right.
What happens if you lose weight but you’re still bloated?
I once had a male patient who lost 50 pounds with me but was still extremely bloated to the point of looking pregnant. He’d lost weight from his arms and his legs, but his stomach still protruded. I suggested doing a test to find out what exactly was going on in his gut microbiome. The patient stopped taking all his laxatives and I advised him to eat a certain way the day before the test, and fast the day of the test.
Upon taking this test, we noticed that his methane-producing bacteria were off the charts, so I treated him for this issue.
Within a month, his stomach deflated two to three inches. It was one of the most obvious demonstrations of the difference between a microbiome in crisis vs. a microbiome in harmony I’ve seen.
How do I know if my microbiome is in crisis?
If you’re experiencing bloating and/or regular discomfort, your best next step is to check your microbiome from home. We have a kit where you can submit your stool sample and you'll get a full report of what your microbiome looks like.
If your microbiome needs further attention, you can schedule a consultation for a telemedicine review. The SIBO test I had my male patient do is not an easy test to do, and often I don't need that information to help a patient, but it’s a tool that’s available if other testing doesn’t reveal sufficient results.
What is SIBO?
More and more people are experiencing SIBO (small intestinal bacterial overgrowth) which is when your bad bacteria have pretty much won. SIBO is a constellation of symptoms of bloating, constipation or diarrhea, fatigue, weight gain, and an increase in cravings. If you have those symptoms, then you want to confirm that you have SIBO, which we’d check through a breath test. Patients can do it with their gastroenterologist, or there are kits you can use at home.
Depending on how bad a patient’s SIBO is, I might suggest a course of antibiotics that target the bad bacteria. I’d also recommend the patient changes their diet to a low FODMAP diet, which is low in the foods that would feed the bad bacteria. So, it's a combination of starving the bacteria through diet and killing them with the course of antibiotics.
What are the consequences of ignoring your microbiome health?
The incidence of autoimmune disease is skyrocketing right now. Autoimmune disorders occur when you have dysbiosis in your gut microbiome, a genetic disposition, and a stress factor.
Metabolic syndrome can also come from an imbalanced microbiome. This is a combination of high blood pressure, high cholesterol, increased blood sugar, obesity, and weight gain that can lead to life-threatening diseases such as heart disease and stroke.
What causes microbiome imbalance?
And what causes this imbalance? Of course, our food choices play a major role. High sugar and processed foods are the culprits here.
You’d also be surprised how much our mental health affects our gut. Depression can throw your microbiome off.
But it is the the trio of having dysbiosis in your gut microbiome, genetic predisposition, and a life stressor that leads to an autoimmune disorder. Autoimmune disorders such as rheumatoid arthritis, dermatomyositis, Hashimoto’s thyroiditis, eczema and psoriasis are among a few different types of autoimmune disorders. While you can’t avoid some of life’s stressors, such as a death in the family or a loss of income, you need to be aware that high long-term stress can cause microbiome imbalance that leads to more serious consequences, such as autoimmune disorders.
How common are microbiome issues?
A lot of people don't know that they have a microbiome issue. They just think they're bloated because they ate something that didn’t agree with them yesterday, but it's a deeper problem than that. I diagnose SIBO about 5 or 6 times a month - around 1 in 5 patients. That doesn't mean that the patients I'm not diagnosing don't have it, it just means that it is corrected in the course of our other treatment.
I’ve found that my male patients are more likely to have SIBO because they're not paying attention to their bloating as much as women are. How many men do you see with a look of pregnancy? Unfortunately, the reality is that a man with a protruding stomach that looks visibly bloated has become a normal sight in the west, and so men rarely acknowledge a problem until they’re extremely uncomfortable. Most just attribute it to a beer belly and get on with their lives, rarely seeking medical advice.
Women tend to be more in-tune with their bodies and notice when something isn’t right. Women also often wear tighter-fitting clothes, so even mild bloating is often noted because women feel the change.
If you catch microbiome imbalance early, you have the control to minimize it from getting worse, or even heal it. The path to balancing the gut microbiome looks different for everyone. For example, if you’ve been on repeat courses of antibiotics, you’ll need to take extra care to restore a healthy microbiome. Or, if you know you have a family history of an autoimmune disorder, you’ll want to pay closer attention to your gut microbiome and take extra care to keep it healthy. If you're noticing that you're gaining weight easily and it's not clear why, it might be because of what's going on in your gut. So, it's important to understand how your gut works so you have the control to improve or treat it when you go through a period of discomfort.
Dr. Nancy Rahnama, MD, ABOM, ABIM, is a medical doctor board certified by both the American Board of Obesity Medicine and the American Board of Internal Medicine. Her specialty is Clinical Nutrition, that is, the use of nutrition by a medical doctor to diagnose and treat disease. Dr. Rahnama has helped thousands of people achieve their goals of weight loss, gut health, improved mood and sleep, and managing chronic disease. In addition to her private practice in Beverly Hills, she is also the co-founder and Director of Nutrition for Dr Nancy MD.
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